The key to who you are isn’t just between your ears. It’s also a few inches lower: in your neck. Lodged between your voice box and collarbone, and wrapped around your windpipe, is your thyroid—and it affects everything you do and are.

A small, butterfly-shaped gland, your thyroid pumps out thyroid hormone, a powerful chemical that works with just about every system in your body to keep your brain sharp, your energy levels up, your reproductive system churning, and your skin, nails, and hair beautiful.

So when it goes on the fritz—and it has for 20 million Americans—everything suffers, and get this: most of those victims are women, according to Dr. Daniel Einhorn, M.D., an endocrinologist at Scripps Memorial Hospital La Jolla. Lucky us, right? The primary cause of thyroid disorders is the immune system attacking the body’s thyroid, and since women are more prone to developing autoimmune diseases (such as lupus and rheumatoid arthritis) than are men, we get the bulk of thyroid conditions, including hyper- and hypothyroidism. According to the University of Maryland Medical Center, women over 50 are at the greatest risk of thyroid disorders.

Your Thyroid (Not) at Work

Thyroid disease, generally, comes in two flavors: over- (hyperthyroidism) and under-active (hypothyroidism). The symptoms of hyperthyroidism—including weight loss, rapid heartbeat, insomnia, irritability, heat intolerance and a constantly “wired” feeling—generally catch women’s attention sooner than those of hypothyroidism. A common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder of the thyroid.

An underactive thyroid, called hypothyroidism, however, is a whole different story. “The symptoms are usually mild and non-specific, so it’s easy to attribute them to many other things… like menopause, for instance,” Einhorn says. According to the U.S. National Library of Medicine, an underactive thyroid can lead to fatigue, brain fog, irregular menstrual periods, weight gain, depression, constantly feeling cold, and even hair loss—all of which also can occur during perimenopause and into menopause. Five to eight times as many women have hypothyroidism than hyperthyroidism. A common cause of hypothyroidism is Hashimoto’s disease.

Is It Menopause or a Thyroid Disorder?

“The symptoms of hypothyroidism and menopause overlap to a great extent,” Einhorn says. “Uniquely menopausal symptoms include hot flashes, loss of periods, and vaginal dryness, but even those may be aggravated by thyroid changes. There are no symptoms that could be absolutely not related to thyroid. We are all different and we change as individuals over time.”

If your thyroid is out of control, all of your efforts to curb perimenopausal and menopausal symptoms, like hot flashes, insomnia, weight gain, hair loss, and achieve hormone happiness will be for naught. What’s more, your symptoms might not be perimenopausal or menopausal at all. So talk to your perimenopause and menopause specialist about your symptoms and when you’re experiencing them. It’s a great first step in determining if your so-called menopausal symptoms are really symptoms of an underactive thyroid. Before your appointment, make sure to chart your symptoms to keep track of what you’re experiencing. Check out these common perimenopause and menopause symptoms and then sign up for my Menopause Mondays® Blog. 

If your perimenopause and menopause specialist isn’t sold on your symptoms stemming from perimenopause or menopause, it’s time for a visit to your primary care physician for follow-up testing. After all, in the end, the only surefire way to tell if your symptoms come from a lack of thyroid hormone or a lack of estrogen is to get your hormones tested, Einhorn indicates.

Put Your Thyroid to the Test

Six in ten people with a thyroid disease don’t know they have it, according to the American Thyroid Association. Usually, all that stands in their way of knowing is a simple blood test.

According to Dr. Einhorn, the most common test to ID a thyroid gland gone haywire is a TSH test, which measures your blood’s levels of thyroid stimulating hormone, a hormone that tells your thyroid to get to work. In the case of an underactive thyroid, TSH levels will be markedly elevated, while low levels can be caused by several conditions, meaning that more testing will be needed to determine if the cause is an overactive thyroid.

A T4 blood test measures your blood’s levels of levothyroxine (a major product of the thyroid gland) and is often used to confirm TSH results and to better pinpoint exact thyroid function levels. A T3 test, which measures another thyroid hormone called triiodothyronine, is sometimes performed, but is generally not necessary for diagnosis, he says.

Getting Back in Balance

If an underactive thyroid’s to blame for your individual set of symptoms and not perimenopause or menopause, your physician will likely prescribe a daily dose of a synthetic thyroid hormone therapy and perform follow-up tests every six to eight weeks and adjust the dosage until the right level is found, usually within three to four months. While the benefit of taking T3 is not proven (and too much T3 can be dangerous), a small number of patients seem to respond better to treatments when they’re combined with T3 supplementation, Einhorn further explains. For hyperthyroidism, treatment often involves a daily drug to slow down your gland’s output.

Luckily, in most cases, simply taking thyroid meds can result in complete symptom resolution.

The Key to a Happy Thyroid

“For better or for worse, hypothyroidism is largely not under our control,” says Einhorn, who notes the disease is primarily genetic. Family history may be the greatest indicator of troubles ahead, but since so many people are undiagnosed, you could have a family history of thyroid disease and have no clue about it.

Also, while the thyroid needs iodine (in tiny amounts) to churn out thyroid hormone, today, so many foods contain iodine that hypothyroidism due to iodine deficiency is extremely rare, he says. If you get enough iodine already, more won’t help anything.

Meanwhile (and here’s more great news for all of the moms out there), pregnancy increases the risk of hypothyroidism both through altering iodine requirements and through reproductive hormones altering thyroid hormone levels, according to the University of Maryland Medical Center. What’s more, some women develop antibodies to their own thyroid during pregnancy, so if you had postpartum thyroiditis, your chances of developing permanent hypothyroidism are also increased. Polycystic ovary syndrome also increases your risk.

Given what we’ve learned from Dr. Einhorn, apparently, there’s really not much you can do to prevent hypothyroidism. But if you do have any of these risk factors, your health can benefit from you staying on the lookout for any new or worsening symptoms.

The signs of a thyroid disorder are easy to dismiss. But, ladies, for the sake of your health and happiness, take a serious look at what’s going on in that second-brain of yours: your thyroid.

Remember:  Suffering in silence is OUT!  Reaching out is IN.

For more great tips on how to find a menopause specialist and deal with menopause download my free ebook: MENOPAUSE MONDAYS  the Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause.    

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